American Journal of Epidemiology
ª The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health.
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Vol. 168, No. 8
Advance Access publication September 8, 2008
Risk of Pancreatitis According to Alcohol Drinking Habits: A Population-based
Louise Kristiansen, Morten Grønbæk, Ulrik Becker, and Janne Schurmann Tolstrup
Received for publication May 6, 2008; accepted for publication June 25, 2008.
The association between alcohol intake and pancreatitis has been examined previously in case-control studies,
mostly consisting of men. The significance of beverage type and drinking pattern is unknown. The objective of this
study was to assess the association between amount, type, and frequency of alcohol intake and risk of pancreatitis.
For this purpose, the authors used data on 17,905 men and women who participated in the Copenhagen City Heart
Study in 1976–1978, 1981–1983, 1991–1994, and 2001–2003 in Copenhagen, Denmark. Alcohol intake and
covariates were assessed by questionnaire. Information on pancreatitis was obtained from national registers.
A high alcohol intake was associated with a higher risk of pancreatitis. Hazard ratios associated with drinking
1–6, 7–13, 14–20, 21–34, 35–48, and >48 drinks/week were 1.1 (95% confidence interval (CI): 0.8, 1.6), 1.2 (95%
CI: 0.8, 1.8), 1.3 (95% CI: 0.8, 2.1), 1.3 (95% CI: 0.7, 2.2), 2.6 (95% CI: 1.4, 4.8), and 3.0 (95% CI: 1.6, 5.7),
respectively, compared with 0 drinks/week (Ptrend< 0.001). Associations were similar for men and women.
Drinking frequency did not seem to be independently associated with pancreatitis.
alcohol drinking; alcoholic beverages; alcohol-induced disorders; pancreatitis; prospective studies
Abbreviations: CI, confidence interval; ICD, International Classification of Diseases.
As early as 1878, alcohol was proposed as a risk factor for
pancreatitis (1), and it is now considered well known that
alcohol increases the risk of pancreatitis. However, epide-
miologic studies on the quantitativeaspect of the association
between alcohol intake and pancreatitis are sparse. To date,
only 4 case-control studies (1–4) and 1 ecologic study (5) on
this subject have been published. In all these studies, an
association was found between alcohol intake and risk of
pancreatitis in men; however, only one of the case-control
studies included women, where surprisingly, no increased
risk of pancreatitis according to alcohol was observed (2).
No studies have assessed the risk of pancreatitis associated
with other dimensions of alcohol intake, such as beverage
type and drinking frequency. It is also uncertain whether
a threshold exists, that is, a level of alcohol intake under
which the risk of pancreatitis is not increased.
In addition to alcohol, gallstone disease is thought to be
an important risk factor for pancreatitis (6) and, because
studies indicate that a moderate intake of alcohol could pro-
tect against gallstone disease (7, 8), the association between
alcohol and risk of pancreatitis might be tempered by gall-
In this study, we examined the association between alco-
hol intake and risk of pancreatitis in a large prospective
cohortconsisting ofmenand womenfromthegeneral Danish
population. Furthermore, we aimed at addressing whether
there may be specific effects of beverage type or drinking
MATERIALS AND METHODS
The data used in this study came from the 4 examinations
of the Copenhagen City Heart Study, performed in 1976–
1978, 1981–1983, 1991–1994, and 2001–2003. Enrolment
and examination procedures have been described in more
Correspondence to J. Tolstrup, National Institute of Public Health, Oster Farimagsgade 5a, DK-1399 Copenhagen K, Denmark (e-mail:
932Am J Epidemiol 2008;168:932–937
by guest on June 5, 2013
18. Haber PS, Wilson JS, Apte MV, et al. Fatty acid ethyl esters
increase rat pancreatic lysosomal fragility. J Lab Clin Med.
19. Nordmann R, Ribiere C, Rouach H. Implication of free radical
mechanisms in ethanol-induced cellular injury. Free Radic
Biol Med. 1992;12(3):219–240.
20. Cederbaum AI. Introduction-serial review: alcohol, oxidative
stress and cell injury. Free Radic Biol Med. 2001;31(12):
21. Chowdhury P, Gupta P. Pathophysiology of alcoholic pancre-
atitis: an overview. World J Gastroenterol. 2006;12(46):
Pancreatitis and Drinking Habits 937
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